US20040215195A1 - Non-metallic orthopedic plate - Google Patents
Non-metallic orthopedic plate Download PDFInfo
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- US20040215195A1 US20040215195A1 US10/423,712 US42371203A US2004215195A1 US 20040215195 A1 US20040215195 A1 US 20040215195A1 US 42371203 A US42371203 A US 42371203A US 2004215195 A1 US2004215195 A1 US 2004215195A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8033—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers
- A61B17/8042—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates having indirect contact with screw heads, or having contact with screw heads maintained with the aid of additional components, e.g. nuts, wedges or head covers the additional component being a cover over the screw head
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/70—Spinal positioners or stabilisers ; Bone stabilisers comprising fluid filler in an implant
- A61B17/7059—Cortical plates
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Abstract
Description
- The present invention relates generally to bone plating systems, and more particularly, to a plating system for use in the treatment of various orthopedic pathologies.
- The treatment of injuries to the spine has advanced significantly, including treatment for many forms of spinal injury and deformities that can occur due to disease, congenital effects, the effects of tumors, and, of course, fractures and dislocations attributable to physical trauma. For many years, the use of elongated rigid plates has been helpful in the stabilization and fixation of the spine.
- It has been found that many plate designs allow for a uni-cortically or bi-cortically intrinsically stable implant. It has also been found that fixation plates can be useful in stabilizing the upper or lower cervical spine in traumatic, degenerative, tumorous or infectious processes. Moreover, these plates provide the additional benefit of allowing simultaneous neural decompression with immediate stability.
- During the many years of development of cervical plating systems, particularly for the anterior approach, various needs for such a system have been recognized. For instance, the plate must provide strong mechanical fixation that can control movement of each vertebral motion segment in six degrees of freedom. The plate must also be able to withstand axial loading in continuity with each of the three columns of the spine. The plating system must be able to maintain stress levels below the endurance limits of the material, while at the same time exceeding the strength of the anatomic structures or vertebrae to which the plating system is engaged.
- Another recognized requirement for a plating system is that the thickness of the plate must be small to lower its prominence, particularly in the smaller spaces of the cervical spine. The screws used to connect the plate to the vertebrae must not loosen over time or back out from the plate. Preferably the plate should be designed to contact the vertebrae for greater stability.
- On the other hand, while the plate must satisfy certain mechanical requirements, it must also satisfy certain anatomic and surgical considerations. For example, the cervical plating system must minimize the intrusion into the patient and reduce the trauma to the surrounding soft tissue. It has also been found that optimum plating systems permit the placement of more than one screw in each of the instrumented vertebrae.
- Many spinal plating systems have been developed in the last couple of decades that address some of the needs and requirements for cervical fixation systems. One example is the Anterior Cervical Plating System disclosed in U.S. Pat. No. 6,152,927, which is hereby incorporated by reference. However, even with the more refined plating system designs, there still remains a need for a spinal plating system that provides a high quality, durable device with modulus and mechanical strength properties similar to that of cortical bone. Metallic implants, with a substantially higher modulus than cortical bone, can cause a phenomenon known as “stress shielding,” which is commonly thought to lead to bone mass loss and the loosening and subsequent failure of some metallic orthopedic implants. Additionally, radiographic qualities of metallic implants often produce imaging artifacts and scatter, which hinder the inspection of bone growth when using conventional imaging via X-ray, CAT scanning, or MRI techniques.
- In order to address the needs left unfulfilled by prior systems, the present invention provides a novel orthopedic plate. In one embodiment, a bone plate comprises a body portion and at least one locking mechanism for engaging the body portion. The body portion is made of a radiolucent material, such as a polymer or polyether ether ketone (PEEK), and includes a plurality of attachment mechanism openings for receiving a plurality of attachment mechanisms, such as bone screws. The at least one locking mechanism is for securing at least one of the plurality of attachment mechanisms when received into the body portion.
- In some embodiments, the bone plate also includes at least one insert affixable with the body portion, the insert for engaging with the locking mechanism. The insert may comprise titanium, aluminum, or some other material that is different than the radiolucent material.
- In some embodiments, the insert includes a rotation-prevention portion to thereby prevent rotation of the insert in the body portion. The insert may also include a metallic material for threadingly engaging with the locking mechanism. Also, the insert may be positioned along a longitudinal axis of the body portion to simultaneously engage with a plurality of locking mechanisms.
- In another embodiment, a bone plate comprises a body formed primarily of a first material, wherein the body includes an opening for receiving an attachment mechanism, such as a bone screw. The bone plate also comprises an insert having one or more engaging portions, the insert including a second material different from the first material. The bone plate may also include a locking mechanism for engaging with the engaging portion. When engaged with the engaging portion, the locking mechanism secures the attachment mechanism in the corresponding opening.
- In some embodiments, the first material is radiolucent, and the second material is radio-opaque. Also in some embodiments, the second material is harder than the first material.
- In another embodiment, a spinal plating system is provided for promoting fusion between two or more vertebral bodies. The spinal plating system includes a plurality of attachment mechanisms, each of the attachment mechanisms having a centerline, and a body formed primarily of a non-metallic radiolucent material. The body includes an upper and a lower surface, and a plurality of attachment mechanism openings for receiving the plurality of attachment mechanisms. The spinal plating system also includes at least one threaded insert formed primarily of a metallic material, the insert being insertable into the at least one locking mechanism opening, wherein the threaded insert threadably receives the threaded locking mechanism, the threaded locking mechanism having a head that extends above the upper surface of the body. Each locking mechanism opening can be situated such that an attachment mechanism received in one of the attachment mechanism openings is lockably held by the threaded locking mechanism.
- Many objects and benefits of the invention will become apparent upon consideration of the following written description of the invention, together with the accompanying Figures.
- FIG. 1 is a top perspective view of an anterior plating system according to one embodiment of the present invention.
- FIG. 2 is a side elevational view of the plating system shown in FIG. 1.
- FIGS. 3a-3 g are top elevational views of a fixation plate in accordance with different embodiments of the present invention, provided in different sizes and configuration.
- FIG. 4 is a partial cross-sectional view of a plate according to an embodiment of the present invention with the fixed angle attachment mechanisms disposed within bone holes in a plate and engaged within a vertebra.
- FIG. 5 is an enlarged end cross-sectional view of the plate according to an embodiment of the present invention with variable angle screws disposed in the plate and engaged in a vertebra.
- FIG. 6a is a bottom perspective view of an anterior plating system according to another embodiment of the present invention.
- FIG. 6b is a top perspective view of a threaded insert for use with the anterior cervical plating system of FIG. 6a.
- FIG. 6c is a side cross-sectional view of the plate shown in FIG. 6a taken along
line 6 c-6 c as viewed in the direction of the arrows. - FIG. 7a is a bottom perspective view of an anterior plating system according to another embodiment of the present invention.
- FIGS. 7b and 7 c are side cross-sectional views of the plate shown in FIG. 7a taken along
line 7 b-7 b and 7 c-7 c, respectively, as viewed in the direction of the arrows. - For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiments, or examples, illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended. Any alterations and further modifications in the described embodiments, and any further applications of the principles of the invention as described herein are contemplated as would normally occur to one skilled in the art to which the invention relates.
- One embodiment of a bone plating system or
fixation assembly 30 is depicted in FIGS. 1 and 2. In the present example, thebone plating system 30 is an anterior cervical plate, but it is understood that other plating systems can also benefit from the present invention. Other examples include plates or bone repair systems that can be used in the leg, the arm, the foot, the hand, or other parts of the body. - In accordance with the present embodiment, the plating system includes an
elongated plate 31 and one or morebone attachment mechanisms 32, such as bone screws. Other bone attachment mechanisms include bolts, staples, and protrusions that can help to secure the plate in a desired position. The attachment mechanisms may be held or retained to theplate 31 by way of one ormore locking assemblies 33. In the embodiments that use attachment mechanisms such as screws or bolts, theelongated plate 31 is provided with a plurality of openings orholes 34 in a variety of arrangements. The plate also can be divided intovertebral level nodes 35 with theattachment mechanisms 32 andopenings 34 aligned at each node. Further, theplate 31 includes recesses between each of thenodes 35 to reduce the outer contour and size of the plate. In addition, the reduced width portion between each of thenodes 35 provides an area of reduced material for additional bending of the plate as may be required by the spinal anatomy. - The
plate 31 is constructed, primarily, of a radiolucent material, such as a polymer based resin. In one embodiment, theplate 31 is constructed substantially from a polyether ether ketone (PEEK) high temperature thermoplastic commercially available by Invibio Biomaterial Solutions of Lancashire, UK under the tradename PEEK-OPTIMA. Using such material, conventional imaging of bony structures associated with theplate 31, such as with X-ray, computerized axial tomography (CAT) scanning, or magnetic resonance imaging (MRI) is improved due to the lack of imaging artifacts and scatter compared to that generated from metallic implants. Also, polymers such as PEEK will bow and bend to a limited degree. This flexibility can be used to provide better healing/fusion between the fractured bone or fused vertebral bodies by allowing increased relative motion and avoiding stress shielding. - The
plate 31 can further include one or more bone growth or fusion-promoting elements, such as bone, bone morphogenetic protein (BMP), demineralized bone matrix (DBM), LIM mineralization proteins (LMP), osteogenic pastes, and so forth. It is understood that such fusion-promoting elements are well known by those of ordinary skill in the art. - The
plate 31 can include a roundedupper edge 36 to reduce irritation of surrounding tissue, for example, in a spinal fusion procedure, the rounded upper edge would be in contact with the soft tissue surrounding the spine. The roundedupper edge 36 reduces the amount of trauma or irritation that would be experienced by the surrounding soft tissue. Thebottom surface 37 of theplate 31 is preferably configured to contact and engage the fractured bone or vertebral bodies at each of the instrumented levels of the spine. In some embodiments, the bottom surface can be textured to enhance its grip on the vertebral body and may have a longitudinal and/or transverse curvature to match the corresponding attachment surface (e.g., the curve of the spine). - Referring now to FIGS. 3a-3 g, several variations of the
elongated plate 31 are depicted. It is understood that the bone plating system according to the present embodiment can be readily adapted to fix several fractured bony pieces or vertebrae, of course depending upon the size/length of the plate and the number and arrangement of attachment mechanisms. For example, the plate depicted in FIGS. 1, 2 and 3 a includes fivevertebral level nodes 35 a so that the plate can be engaged to five vertebrae of the spine. Theplate 31 a of FIG. 3a could be used to fix the vertebrae C2-C6, although the plate also may be used in thoracic, lumbar, and sacral regions of the spine. Theelongated plates 31 b depicted in FIG. 3b is sized and configured to span three vertebrae, depending upon the instrumented vertebral levels. In this instance, theplate 31 b includes threevertebral level nodes 35 b, with two nodes at the opposite ends of the plate and one node with attachment mechanisms offset from each other in the middle portion of the plate to accommodate variation in vertebral anatomy. - A modification of the
plate 31 b is depicted in FIG. 3c. In this case, theplate 31 c includes threenodes 35 c, with the nodes on the opposite side of the middle portion of the plate being directly aligned at the same vertebral level. The plates of FIGS. 3d-3 e, namelyplates 31 d and 31 e, are similar to theplate 31 c although their lengths are progressively shorter to accommodate varying vertebral body height. The last twoplates nodes - The
elongated plates 31 a-31 g can provide a variety of hole patterns at each of thenodes 35 a-35 g. These hole patterns can provide for at least two attachment mechanisms (e.g., screws) to be engaged into each respective bony portion (e.g., vertebral body). As discussed above, it has been found that the placement of two or more screws in each vertebral body improves the stability of the construct. - The present embodiments may also provide a mechanism for locking the attachment mechanisms to the elongated plate to prevent backout, loosening, or other dis-engagement of the attachment mechanisms. Consequently, in a further aspect of the embodiments, various openings hole patterns may be provided. One pattern is an
end hole pattern 38, as shown at the ends ofplate 31 in FIG. 1 and plate 31 a in FIG. 3a. In this arrangement, twoscrew holes 34 are laterally disposed at asingle node 35 a. A single locking assembly may be disposed between the twoscrew holes 34 and configured to lock attachment mechanisms disposed within theplate 31 a. The locking assembly can be a machine screw that engages with threads in theplate 31 a, or can be a self-tapping screw that cuts through the plate as it is advanced therein. Other types of locking assemblies include a rotatable disk, lever, or rivet shaped to selectively allow one or more attachment mechanisms to be inserted and locked; a deformable portion (e.g., a washer) that selectively allow one or more attachment mechanisms to be inserted and locked; strap/tie mechanisms that can be used to selectively tie down one or more attachment mechanisms; and a sliding member for moving between different positions to selectively allow one or more attachment mechanisms to be inserted and locked. A similar arrangement can be provided by themiddle hole pattern 39 in which two screw holes are situated at a single vertebral level. A locking assembly can be disposed between the two attachment mechanism holes and configured to lock the respective attachment mechanisms. - The present embodiment further contemplates a plate carrying four-attachment mechanism patterns. For the sake of example, the four-
hole pattern 40 illustrated in FIG. 1 and FIGS. 3a and 3 d, provides for four bone screws holes in a diamond pattern. Asingle locking assembly 33 can be centrally disposed between all of the attachment mechanism holes so that attachment mechanisms within the respective holes are simultaneously locked by the single locking assembly. In the fivenode plate 31 a of FIG. 3a, two such four-hole patterns 40 are provided. In the three-node plate 31 d of FIG. 3d, only a single four-hole pattern 40 is required. It can be appreciated that the four-hole pattern 40 provides a great degree of flexibility to the surgeon in determining howmany attachment mechanisms 32 will be engaged into a single vertebra, and in what arrangement. For example, as shown in FIG. 1, two screws are situated in the laterally opposite screw holes at thevertebral level node 35. Alternatively, attachment mechanisms could be placed in the longitudinally opposite screw holes oriented along the length of theplate 31 a. Other arrangements contemplate attachment mechanisms being placed in immediately adjacent screw holes 34, or placing three attachment mechanisms in three of the holes of the four-hole pattern 40. Again, the selection of attachment mechanisms and their arrangement can be left to the surgeon and will be based upon the type of correction or fixation required and the anatomy of bony member being addressed. - A further arrangement for attachment mechanisms is provided by the four-
hole cluster 41 depicted in FIGS. 3b and 3 c. In the four-hole cluster 41 inplate 31 b, two hole pairs 41 a and 41 b are provided. Each of the hole pairs may include its own locking assembly to lock the two attachment mechanisms (e.g., screws) into the screw bores of the respective hole pairs. As shown in FIG. 3b, the orientation of the particular hole pairs provides one screw hole from each pair generally laterally relative to each other in a single bony portion (e.g., vertebra). The other of the attachment mechanism holes in each respective pair is longitudinally offset from the central screw holes, being disposed closer to the ends of theplate 31 b. In this manner, the two central holes of each of the two holes pairs can be engaged in a single vertebra, while the remaining screw holes of the hole pairs 41 a and 41 b can be disposed in the superior and inferior adjacent vertebrae. Most preferably, however, each of the screw holes in the four-hole cluster 41 is generally oriented over or slightly offset from a single vertebra. The surgeon then has the option to selected any of the screw holes in the two hole pairs 41 a or 41 b that is optimally aligned over the vertebra. - A similar arrangement is found in the plate31C which includes a four-
hole cluster 42. In this example, it can be seen that the four-hole cluster 42 includes two hole pairs 42 a and 42 b, in a manner similar to the four-hole cluster 41 of FIG. 3b; however in this case, the hole pairs are arranged closer to each other, principally because theplate 31 c is shorter than theplate 31 b. In both of the four-hole clusters - The invention further contemplates a three-hole pattern, such as
pattern 43 provided in theplate 31 f in FIG. 3f. In this example, a single locking assembly is used to fix three attachment mechanisms within the respective screw holes. A five-hole pattern 44 is provided onplate 31 g, as shown in FIG. 3g. In this example, a single hole is arranged centrally between four outlying holes. Twolocking assemblies 33 are provided to lock a pair of the outlying four screw holes together with the central hole. In this configuration, the central hole is held in place by two locking assemblies, while each of the outlying pair of holes is held in place by a single locking assembly. - Referring now to FIGS. 4 and 5, the use of the
fixation plate assembly 30 is illustrated using, for the sake of example, bone screws for affixing to a vertebral body V. In FIG. 4, a pair of fixed angle screws 50 are disposed withinrespective bores 34 so that the threadedshanks 51 project beyond thelower surface 37 of theplate 31 and into the vertebral body V. The threaded shank is preferably configured to engage the cortical and cancellous bone of the vertebral body V. Theintermediate portion 52 of the fixedangle screw 50 extends through the cylindrical bore 77 of the screw holes 34. Thespherical surface 57 of thehead 54 of the screw contacts thespherical recess 75 of thescrew hole 34 as the fixedangle screw 50 is threaded into the vertebral body V. Once thescrew 50 is completely seated within thespherical recess 75, theintermediate portion 52 provides a snug relationship relative to the cylindrical bore 77 so that the fixedangle screw 50 is not able to pivot or translate relative to theplate 31. - In order to ensure secure fixation of the
screw 50 withinplate 31, the lockingassembly 33 is tightened onto theheads 54 of the twoattachment mechanisms 50. In particular, alocking mechanism 85, such as a locking screw, is threaded into thebore 70 to draw thewasher 90 into contact with the screw heads. In the present embodiment, thebore 70 is already tapped, although in other embodiments thelocking mechanism 85 may be a self tapping screw. Further embodiments of thelocking mechanism 85 include a disk, lever, rivet, or other mechanical structure configured or shaped to selectively allow one or more attachment mechanisms to be inserted and/or locked; a deformable portion (e.g., a washer) that selectively allow one or more attachment mechanisms to be inserted and/or locked; strap/tie mechanisms that can be used to selectively tie down one or more attachment mechanisms; and a sliding member for moving between different positions to selectively allow one or more attachment mechanisms to be inserted and/or locked. - The
convex surface 92 seats against thespherical surface 57 of the attachment mechanism heads 54 to firmly seat the screw heads within the platespherical recess 75. In some embodiments, the lockingwasher 90 can advance sufficiently far into the lockingrecess 71 to rest substantially flush with thetop surfaces 56 of theattachment mechanisms 50. - In a further aspect of the present embodiments, the locking
assembly 33 can be loosely fixed on theplate 31 so that the surgeon does not have to attach the locking assembly when the plate is engaged to a vertebra or other bony member. In the present example, thelocking mechanism 85 is a screw that is pre-threaded through the lockingwasher 90 and into the tapped bore 70 until about three or fewer threads of the locking screw project below thebottom surface 37 of the plate. The lockingscrew 85 is then staked at the thread furthest from the plate so that the screw cannot be removed or backed out through the tapped bore 70. Of course, the lockingscrew 85 can be advanced further through thebore 70—when it is necessary to enable the lockingassembly 33. As previously mentioned, thesharp point 86 a of the lockingscrew 85 is preferably configured to penetrate the cortical bone. With the locking screw staked to the plate, thesharp point 86 a will penetrate the vertebra V when theplate 31 is initially positioned on the bone. In this instance, the lockingscrew 85 helps locate and temporarily stabilize the plate on the vertebra V as theattachment mechanisms 50 are implanted into the bone. This temporary location feature provided by the lockingscrew 85 can also be used when a drill guide is used to drill and tap the vertebra to receive theattachment mechanisms 50. - The locking
assembly 33 can be configured so that thewasher 90 can be moved clear of the screw holes 34 when the lockingscrew 85 is staked to theplate 31. Thus, even with the lockingassembly 33 in its loosened position, theattachment mechanisms - The use of the variable
angle attachment mechanism 60 is depicted in FIG. 5. The lockingassembly 33 functions as described above to lock theheads 64 of the variable angle screws 60 within theplate 31. Specifically, theconvex surface 92 of thewasher 90 contacts and applies pressure to thespherical surfaces 67 of therespective attachment mechanisms 60. However, with the variable angle screws 60, the intermediate portion 62 does not fit snugly within the cylindrical bore 77 of the screw holes 34. Thus, even with thehead 64 of eachscrew 60 residing solidly within thespherical recess 75, theattachment mechanism 60 can still be angulated relative to the plate and to the axis of thespherical recess 75 andcylindrical bore 77. It is understood that the degree of angulation is restricted by the difference in diameters between thecylindrical bore 77 and the intermediate portion 62 of thevariable angle screw 60. In one preferred embodiment, the relative diameters permit angulation of up to 20° from the axis 75 a of therecess 75 and bore 77. - During implantation, the variable angle capability of the
screw 60 allows the surgeon to place the attachment mechanism within the vertebra at any angle within the defined angulation limits (20° in one specific embodiment). Thus, thevariable angle screw 60 provides greater flexibility than does the fixedangle screw 50 for orienting the attachment mechanism relative to the anatomy of the vertebra. Moreover, this variable angle capability allows a limited degree of micro-motion between the screw and the plate when thefixation assembly 30 is implanted within a patient. In other words, as the spine is loaded and as load is transmitted through the screws and plate, the plate and vertebra may translate relative to each other. Thevariable angle screw 60 accommodates this relative movement by pivoting within thespherical recess 75. On the other hand, the fixedangle screw 50 prevents this relative movement. The choice between using a fixed or a variable angle screw can be left to the surgeon depending upon the pathology being treated. Thefixation plate assembly 30 according to the present embodiment allows this choice to be made at any point during the surgical procedure. - The
plating system 30 of FIGS. 1-5 include many benefits. By using a non-metallic substance such as PEEK, theplate 31 obtains a degree of flexibility, when compared to metallic plates, while still providing a strong mechanical fixation that can control movement of each vertebral motion segment in six degrees of freedom. Theplating system 30 is also be able to withstand axial loading in continuity with each of the three columns of the spine. Theplating system 30 is able to maintain stress levels below the endurance limits of the PEEK material, while at the same time exceeding the strength of the anatomic structures or vertebrae to which the plating system is engaged. The thickness of theplate 31 is relatively small, thereby lowering its prominence, particularly in the smaller spaces of the cervical spine. The PEEK material allows locking screws to be self-tapped, as contrasted with metallic plates. And, the flexible properties of the PEEK material help to prevent attachment mechanisms from loosening or backing out from theplate 31 and the vertebral bodies. - Referring now to FIGS. 6a-6 c, in another embodiment of the
plating system 30,plate 31 h is similar to plate 31 f (FIG. 3f) with the inclusion of ametallic insert 100. In the present embodiment, the metallic insert is made of titanium aluminum, or ceramic, although other materials can also be used. Themetallic insert 100 is used for part of the lockingassembly 33 to provide an improved interface for receiving and securing the lockingscrew 85. - Referring specifically to FIG. 6b, the
metallic insert 100 includes an oval shapedportion 102 and acylindrical portion 104. Thecylindrical portion 104 includes a threadedinterior wall 106 for receiving and threadingly engaging with thelocking mechanism 85. Referring to FIGS. 6a and 6 c, in one embodiment, themetallic insert 100 is pressed into theplate 31 h, preferably when the plate is in a more malleable state. - The
plating system 30 of FIGS. 6a-6 c include many benefits. In addition to the benefits listed above with reference to FIGS. 1-5, themetallic inserts 100 provide extra strength for thelocking assemblies 33. Also, themetallic inserts 100 are easily threaded, so that thelocking mechanism 85 can be of a very tight manufacture (e.g., a tightly threaded screw as compared to a self-tapping screw). The oval shapedportion 102 prevents any rotation of theinsert 100 when thelocking mechanism 85 is being inserted into or removed from theplating system 30. Also, the oval shapedportion 102 prevents the insert from being removed in a direction opposite to thebottom surface 37 of theplate 31. - Referring now to FIGS. 7a-7 c, in another embodiment of the
plating system 30,plate 31 i is similar to plate 31 e (FIG. 3e) with the inclusion of ametallic insert 110. In the present embodiment, the metallic insert is made of titanium or aluminum, although other materials can also be used. Themetallic insert 110 extends along a longitudinal axis of theplate 31 i, thereby stiffening and strengthening the plate and reducing an amount of bow that would otherwise occur. Themetallic insert 110 also provides anti-compression strength along its longitudinal axis. In some embodiments, themetallic insert 110 provides one or more threaded interior walls 112 for receiving and threadingly engaging with screw-type locking mechanisms 85. The extended shape of themetallic insert 110 prevents any rotation of theinsert 100 when thelocking mechanism 85 is being inserted into or removed from theplating system 30. Although themetallic insert 110 is illustrated as a single unit, it may be comprised of multiple units. - In one embodiment, the
metallic insert 110 is formed as a dove tail, with an upper surface (as shown in FIG. 7c) that is larger than its lower surface. The dove tail shape of the metallic insert fits like a “key” into acorresponding slot 114 of theplate 31 i. In the present embodiment, the dove tail shape also allows theinsert 110 to be slid into theplate 31 i, so that one or more of the threaded portions of the insert are aligned with one or more of thebores 70. In some embodiments, apin 116 may also (or alternatively) be used to secure themetallic insert 110 into the plate. It is known that there are many different ways to secure themetallic insert 110 to theplate 31 i, and the locking screws 85 themselves can be the sole source of securement. - The
plating system 30 of FIGS. 7a-7 c include many benefits. In addition to the benefits listed above with reference to FIGS. 1-6c, themetallic inserts 110 provide extra strength for several different locking screws 85. A singlemetallic insert 110 can easily be slid into theplate 31 i, thereby making manufacturing easier. Alternatively, several metallic plates (e.g., one for each locking screw 85) can be sequentially slid into theslot 114 of theplate 31 i, thereby having a reduced number of insert sizes accommodating the different potential shapes and lengths (e.g., FIGS. 3a-3 g) that may be used for theplate 31 i. - Although only a few exemplary embodiments of this invention have been described in detail above, those skilled in the art will readily appreciate that many modifications are possible in the exemplary embodiments without materially departing from the novel teachings and advantages of this invention. For example, one or more visualization windows (apertures) can be made in the
plate 31 to facilitate the visual placement of the plating system by a surgeon. Also, features illustrated and discussed above with respect to some embodiments can be combined with features illustrated and discussed above with respect to other embodiments. Accordingly, all such modifications are intended to be included within the scope of this invention.
Claims (29)
Priority Applications (10)
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US10/423,712 US7169150B2 (en) | 2003-04-25 | 2003-04-25 | Non-metallic orthopedic plate |
PCT/US2004/010093 WO2004096068A1 (en) | 2003-04-25 | 2004-03-31 | Non-metallic orthopedic plate |
EP04760226A EP1622528B1 (en) | 2003-04-25 | 2004-03-31 | Orthopedic plate with insert |
JP2006509597A JP4564487B2 (en) | 2003-04-25 | 2004-03-31 | Non-metallic orthopedic plate |
CNA200480013593XA CN1791365A (en) | 2003-04-25 | 2004-03-31 | Non-metallic orthopedic plate |
CA002523305A CA2523305A1 (en) | 2003-04-25 | 2004-03-31 | Non-metallic orthopedic plate |
AU2004233785A AU2004233785B2 (en) | 2003-04-25 | 2004-03-31 | Non-metallic orthopedic plate |
AT04760226T ATE517583T1 (en) | 2003-04-25 | 2004-03-31 | ORTHOPEDIC PLATE WITH INSERT |
KR1020057020326A KR101074180B1 (en) | 2003-04-25 | 2005-10-25 | Non-metallic orthopedic plate |
US11/668,292 US8617222B2 (en) | 2003-04-25 | 2007-01-29 | Non-metallic orthopedic plate |
Applications Claiming Priority (1)
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US10/423,712 US7169150B2 (en) | 2003-04-25 | 2003-04-25 | Non-metallic orthopedic plate |
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EP (1) | EP1622528B1 (en) |
JP (1) | JP4564487B2 (en) |
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CN (1) | CN1791365A (en) |
AT (1) | ATE517583T1 (en) |
AU (1) | AU2004233785B2 (en) |
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Also Published As
Publication number | Publication date |
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EP1622528B1 (en) | 2011-07-27 |
ATE517583T1 (en) | 2011-08-15 |
CA2523305A1 (en) | 2004-11-11 |
CN1791365A (en) | 2006-06-21 |
JP4564487B2 (en) | 2010-10-20 |
US7169150B2 (en) | 2007-01-30 |
JP2006524538A (en) | 2006-11-02 |
WO2004096068A1 (en) | 2004-11-11 |
US20080033437A1 (en) | 2008-02-07 |
AU2004233785B2 (en) | 2010-05-27 |
US8617222B2 (en) | 2013-12-31 |
EP1622528A1 (en) | 2006-02-08 |
KR20050113286A (en) | 2005-12-01 |
AU2004233785A1 (en) | 2004-11-11 |
KR101074180B1 (en) | 2011-10-14 |
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